Apoptosis as a prognostic factor in colorectal carcinoma.

我们通过末端脱氧核苷酸转移酶介导的dUTP-生物素缺口末端标记法（TUNEL）研究了104例结直肠癌中凋亡细胞死亡的发生情况，以检查凋亡是否可作为预后因素。凋亡指数（AI）计算为每1,000个癌细胞中阳性癌细胞的百分比。AI的中位数为4.1（范围，1.9-4.7）。在具有较高分化潜能的肿瘤中，如晚期肿瘤（Dukes B、C和D），细胞凋亡的频率低于Dukes A（p<0.05），并且在具有中等分化证据的肿瘤中，细胞凋亡的频率低于具有良好分化证据的肿瘤（p<0.05）。有静脉侵犯或淋巴结转移者，其阳性率也低于无静脉侵犯或淋巴结转移者（P<0.05）。此外，在Dukes C期肿瘤中具有高AI的亚组（5年生存率为33%对68%，p<0.05 ; Cox-Mantel）。我们的研究结果表明，较少的细胞凋亡可能导致更大的进展，大肠癌的细胞凋亡率可能是恶性程度的指标之一。此外，肿瘤细胞凋亡的频率可能是有用的预后因子在大肠癌。

We investigated the occurrence of apoptotic cell death in 104 colorectal carcinomas byterminal-deoxynucleotidyl-transferase-mediated dUTP-biotin nick end labeling (TUNEL) in order to examine whether or not apoptosis might be useful as a prognostic factor. An apoptotic index (AI) was caluculated as the percentage of positine cancer cells per 1,000 cancer cells. The median value of AI was 4.1 (range, 1.9-4.7). Apoptosis was less frequently-observed in tumors with higher malignannt potential, such as tumors at advanced stages (Dukes B,C and D), than at Dukes A (p<0.05), and it was less frequent in tumors with evidence of moderate differentiation than in those with evidence of well differentiation (p<0.05). It was also less frequent in tumors with venous invasion or lymph node metastasis than in those without these features (p<0.05). Moreover, the subgroup with a high AI in tumors at Dukes stage C (five-year survival rates were 33% vs. 68%, p<0.05 ; Cox-Mantel). Our findings suggest that less apoptosis might result in greater progression of colorectal carcinomas and the rate of apoptosis might be one of the indicators of the degree of malignancy. Moreover, it appears that the frequency of apoptosis in tumor cells might be useful prognostic factor in colorectal carcinoma.